Current opinion in pulmonary medicine
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Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. This major public health threat is ranked twelfth as a worldwide burden of disease and is projected to rank fifth by the year 2020 as a cause of lost quantity and quality of life. The impact of this disease in women is significantly understudied but the evidence that does exist reveals potentially substantial gender differences in the susceptibility to, severity of, and response to management of COPD. ⋯ Chronic obstructive pulmonary disease in women is an understudied subject but is gaining attention as a significant public health threat. In developed countries, efforts at preventing the initiation of tobacco smoking and targeting smoking cessation programs in women are needed. In developing countries, efforts to promote cleaner fuels, improved stoves, better home ventilation, reduce toxic dust and fume exposures, combat infectious diseases such as TB and HIV, and improve nutrition are all ways in which the lung health of women can be improved.
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Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States, as well as a major cause of disability. In its end stages, its inexorable progression results in profound suffering for those afflicted. Medical therapy has proven largely ineffective in improving dyspnea and functional status, and does not alter pulmonary function. Over the past decade, lung-volume reduction surgery (LVRS) has been proposed as a palliative treatment for certain subgroups of COPD patients with emphysema, but initial enthusiasm over its application had been confounded by uncertainty about the potential cost and morbidities associated with LVRS, as well as durability of its beneficial effects. Longer-term follow-up data of initial uncontrolled trials along with several landmark controlled trials have recently been published, offering insight as to the "proper" place of LVRS in the treatment of these unfortunate patients. This review will summarize and offer perspective on these recent findings, as well as offer thoughts on recent refinements in preoperative imaging assessment, and pioneering efforts in less invasive bronchoscopic lung-volume reduction that should further aid the clinician in defining who should benefit from this treatment approach. ⋯ Lung-volume reduction surgery can improve both objective and subjective measures of lung performance in properly selected COPD patients. Durable effects of up to 5 years have now been demonstrated. As costs (both fiscal and emotional) of such an approach are high, refinement in patient selection remains a current goal in the surgical approach to COPD.
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Asthma is a phenotypically heterogeneous disorder and, over the years, many different clinical subtypes of asthma have been described. A precise definition of asthma phenotypes is now becoming more and more important, not only for a better understanding of pathophysiologic mechanisms, but in particular to ascertain the specific genes associated with these phenotypes. ⋯ The classic phenotype of IgE-mediated asthma starting in childhood is now clearly defined. However, many other phenotypes of asthma in childhood as well in adulthood are being recognized. In particular, asthma starting in adulthood and noneosinophilic asthma constitute an important part of the adult asthma population, and are still poorly defined. A precise definition of these asthma phenotypes is urgently needed because they are likely to be associated with different genotypes, responses to treatment, and prognoses.
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It has been an ongoing challenge to translate knowledge pertaining to the molecular basis of cystic fibrosis (CF) into a clear understanding of the development of CF lung disease. Various hypotheses have attempted to explain the apparent breach of innate defenses in CF, although a definitive explanation has been elusive. ⋯ With a better understanding of pathogenic steps leading to CF lung disease, we may now be able to direct the development of therapies that will substantially improve disease outcomes.